Multiple Pregnancy: Should I Consider a Multifetal Pregnancy Reduction

Guides through decision to have a multifetal pregnancy reduction. Discusses comparisons between twins after fetal reduction versus triplets (no fetal reduction). Covers benefits and risks. Includes an interactive tool to help you make your decision.

Multiple Pregnancy: Should I Consider a Multifetal Pregnancy Reduction?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Your options

Have multifetal pregnancy reduction. This procedure reduces the
number of fetuses.

This information is for women who are pregnant with three
or more fetuses. It's also for their partners.

Key points to remember

Having fewer fetuses lowers all risks. This makes it more
likely that you will have a healthy pregnancy and a healthy baby or
babies.

The risk of premature birth is higher when you are carrying multiple fetuses, which increases an
infant's chances of having severe health problems.

This procedure to reduce the number of fetuses can cause
miscarriage of the remaining fetuses. The chance of
this happening when triplets are reduced to twins is about 6 out of 100
pregnancies. This means that a miscarriage doesn't happen in 94 out of 100 of
these procedures.1

Early genetic testing (chorionic villus sampling) and
fetal ultrasound can help you find out if any of the
fetuses has a problem. This information may help you decide about reducing the
number of fetuses.

This decision may be emotional and complex. For some people,
it raises ethical and spiritual concerns.

Multifetal pregnancy reduction is a procedure to reduce the number of fetuses in a
pregnancy—usually from three, four, or five fetuses to two. This may help the
two fetuses survive and help you have a healthy pregnancy.

This
procedure is most often done early in a pregnancy, between the 9th and 12th
weeks. It's often done after genetic testing to find out if the fetuses have
any problems.

It's usually done through the belly. Using
ultrasound as a guide, the doctor puts a needle into
the uterus to the selected fetus or the
umbilical cord. The doctor injects the fetus or the
cord with a medicine that stops the heart.

Reduced risk for mother. The procedure
reduces the mother's risk of problems. These risks include
gestational diabetes,
preeclampsia, and
anemia. These risks increase with each added
fetus.

Reduced risk for infants. The procedure may improve your chances of carrying your pregnancy longer and your chances of delivering one or more healthy babies.

Carrying triplets or more increases the risk
of miscarriage, stillbirth, premature birth, and disability.

Reduced stress related to infant care.
Caring for three or more babies can be stressful, especially if any of them has
health problems.

Reduced cost of caring for multiples. The hospital care for three or more infants can be expensive.
Because multiple babies have an increased chance of premature birth and
illnesses, they are cared for in a neonatal intensive care unit (NICU). Caring
for the babies at home also could be costly. After they come home, premature
babies often need medicines, medical equipment and supplies, and extra doctor
visits.

Miscarriage of the
other fetuses. About 6 out of 100 triplet-to-twin procedures lead to
miscarriage.1 This also means
that 94 out of 100 triplet-to-twin procedures don't cause a miscarriage. The miscarriage rate is highest when reducing from 6 or more fetuses. The miscarriage rate is lower if there are fewer fetuses at the start of the procedure.2

Emotional risks for you, especially if
the pregnancy miscarries. Some parents who go on to have a healthy pregnancy
view the reduction as sad but medically needed. Others who have had a reduction
followed by a healthy pregnancy say they felt grief, guilt, and depression
about their decision. But for many women these feelings usually are reduced with time.3

Infection of the belly or uterus. This
is rare.

Some couples choose to implant fewer embryos to reduce
the chance of a pregnancy of triplets or more, rather than consider having this
procedure.

Compare your options

Compare

What is usually involved?

What are the benefits?

What are the risks and side effects?

Have fetal reduction
Have fetal reduction

You will have an ultrasound
test to make sure that the fetus or fetuses to be reduced are in their own
amniotic sac. Separate sacs reduce the chance of miscarriage. A different
procedure may be done if the fetuses are in the same sac.

It's done in the doctor's office. It takes only a few
minutes.

You will be watched at the doctor's office afterward to
make sure that the remaining fetuses are doing well.

Having fewer fetuses
reduces the risk of miscarriage, stillbirth, premature birth, and
disability.

You have a lower chance of problems in your pregnancy,
such as
gestational diabetes,
preeclampsia, or
anemia. These risks increase with each added
fetus.

You could
miscarry the remaining fetuses. When reducing from a triplet to a twin
pregnancy, the miscarriage rate is about 6 out of 100 pregnancies. This means that
a miscarriage doesn't happen in 94 out of 100 of these procedures.1 The risk of miscarriage from the procedure is highest when reducing from 6 or more fetuses. The risk of miscarriage is lower if there are fewer fetuses at the start of the procedure.4

You could have an infection in your belly or uterus. This is
rare.

Some parents have grief, guilt, and depression about
reducing the number of fetuses. But these feelings may decrease with time.3

Carry three or more
fetuses Carry three or more
fetuses

You will see your
doctor more often during your pregnancy.

You will likely see a
perinatologist. This doctor takes care of women who
may have a problem in their pregnancy.

You may have more tests than
you would in a pregnancy with one fetus.

You may avoid the emotional stress that some people feel about reducing the number of fetuses.

You have a lower risk of infection.

Carrying triplets or more increases the risk of miscarriage, stillbirth, premature birth, and disability.

Multiple pregnancy increases the mother's risk of problems such
as gestational diabetes, preeclampsia, and anemia. These risks increase with
each added fetus.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about multifetal pregnancy reduction

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

When my
husband and I learned we were expecting three babies, we were thrilled.
But along with that news we heard about the risks for them and me. I'm
already at risk for pregnancy problems, since I've had gestational diabetes
before. So we decided to have a multifetal pregnancy reduction. What convinced
me was the knowledge that the miscarriage rate is higher for triplet pregnancy
than it is for the twins after the procedure. And it went well for us. We took
the risk, and the babies and I are doing well.

Pam, age 37

Because of
my age, our fertility doctor encouraged us to have four embryos transferred for
my in vitro. We were surprised that all of them took and were worried about the
risks. After talking for a few days about having a multifetal pregnancy
reduction, my husband and I decided not to have one. We were more comfortable
with letting nature take its course. And it did—by the second trimester, two
were gone, and I was carrying twins.

Maya, age 43

We knew
right away that carrying five babies was not going to work for them or me. So
I had a multifetal pregnancy reduction. Then I miscarried. Even though it
seemed like the obvious course to take, I'll never stop feeling terrible about
it.

Jenny, age
39

I just couldn't bring myself to have a
multifetal pregnancy reduction, even though my doctor told me that my pregnancy
was high-risk. I'll never know whether it would have gone better if I'd had the
procedure, but trying to carry the four babies didn't go well. One died after
birth, and now we have the challenge of raising triplets, one of which is
disabled.

Joelle, age
35

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have fetal reduction

Reasons to carry triplets or more

I want to increase the chance of having two healthy babies.

I want to try to have all my babies.

More important

Equally important

More important

I want to lower my chance of having a problem like preeclampsia.

I may not have any problems. But if I do, my doctor and I can decide about treatment then.

More important

Equally important

More important

My ethical and spiritual values would allow me to have fetal reduction.

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Fetal reduction

Having triplets or more

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.

Does a fetal reduction lower the chance that your remaining baby or babies will have a disability?

YesYou're right. A fetal reduction lowers the chance that your remaining baby or babies will have a disability. It also lowers the chance of a fetus or infant dying or being ill.

NoSorry, that's not right. A fetal reduction does lower the chance that your remaining baby or babies will have a disability. It also lowers the chance of a fetus or infant dying or being ill.

I'm not sureIt might help to go back and read "What are the benefits of a multifetal pregnancy reduction?" A fetal reduction does lower the chance that the remaining babies will have a disability.

2.

Is your risk of having a miscarriage higher with a fetal reduction than it is with having triplets or more?

YesSorry, that's not right. The risk of miscarriage is higher from having triplets or more than it is from having a fetal reduction.

NoYou're right. The risk of miscarriage is higher from having triplets or more than it is from having a fetal reduction.

I'm not sureIt may help to go back and read "What are the risks of multifetal pregnancy reduction?" The risk of miscarriage is higher from having triplets or more than it is from having a fetal reduction.

3.

Do both choices have emotional side effects?

YesYou're right. Either choice can be emotional and complex. You may feel guilty if you reduce the number of fetuses. But you may have a hard time raising multiples.

NoSorry, that's not right. Either choice can be emotional and complex. You may feel guilty if you reduce the number of fetuses. But you may have a hard time raising multiples.

I'm not sureIt may help to go back and read "Compare your options." You may feel guilty if you reduce the number of fetuses. But you may have a hard time raising multiples.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Multiple Pregnancy: Should I Consider a Multifetal Pregnancy Reduction?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

Carry a pregnancy with three or more fetuses.

Have multifetal pregnancy reduction. This procedure reduces the
number of fetuses.

This information is for women who are pregnant with three
or more fetuses. It's also for their partners.

Key points to remember

Having fewer fetuses lowers all risks. This makes it more
likely that you will have a healthy pregnancy and a healthy baby or
babies.

The risk of premature birth is higher when you are carrying multiple fetuses, which increases an
infant's chances of having severe health problems.

This procedure to reduce the number of fetuses can cause
miscarriage of the remaining fetuses. The chance of
this happening when triplets are reduced to twins is about 6 out of 100
pregnancies. This means that a miscarriage doesn't happen in 94 out of 100 of
these procedures.1

Early genetic testing (chorionic villus sampling) and
fetal ultrasound can help you find out if any of the
fetuses has a problem. This information may help you decide about reducing the
number of fetuses.

This decision may be emotional and complex. For some people,
it raises ethical and spiritual concerns.

FAQs

What is multifetal pregnancy reduction?

Multifetal pregnancy reduction is a procedure to reduce the number of fetuses in a
pregnancy—usually from three, four, or five fetuses to two. This may help the
two fetuses survive and help you have a healthy pregnancy.

This
procedure is most often done early in a pregnancy, between the 9th and 12th
weeks. It's often done after genetic testing to find out if the fetuses have
any problems.

It's usually done through the belly. Using
ultrasound as a guide, the doctor puts a needle into
the uterus to the selected fetus or the
umbilical cord. The doctor injects the fetus or the
cord with a medicine that stops the heart.

Sometimes vaginal
bleeding happens afterward. This is normal.

The dead
embryo or fetus is absorbed by the mother's body. This
is similar to what happens with
vanishing twin syndrome.

What are the benefits of a multifetal pregnancy reduction?

Reduced risk for mother. The procedure
reduces the mother's risk of problems. These risks include
gestational diabetes,
preeclampsia, and
anemia. These risks increase with each added
fetus.

Reduced risk for infants. The procedure may improve your chances of carrying your pregnancy longer and your chances of delivering one or more healthy babies.

Carrying triplets or more increases the risk
of miscarriage, stillbirth, premature birth, and disability.

Reduced stress related to infant care.
Caring for three or more babies can be stressful, especially if any of them has
health problems.

Reduced cost of caring for multiples. The hospital care for three or more infants can be expensive.
Because multiple babies have an increased chance of premature birth and
illnesses, they are cared for in a neonatal intensive care unit (NICU). Caring
for the babies at home also could be costly. After they come home, premature
babies often need medicines, medical equipment and supplies, and extra doctor
visits.

What are the risks of multifetal pregnancy reduction?

The risks of reducing the number of fetuses include:

Miscarriage of the
other fetuses. About 6 out of 100 triplet-to-twin procedures lead to
miscarriage.1 This also means
that 94 out of 100 triplet-to-twin procedures don't cause a miscarriage. The miscarriage rate is highest when reducing from 6 or more fetuses. The miscarriage rate is lower if there are fewer fetuses at the start of the procedure.2

Emotional risks for you, especially if
the pregnancy miscarries. Some parents who go on to have a healthy pregnancy
view the reduction as sad but medically needed. Others who have had a reduction
followed by a healthy pregnancy say they felt grief, guilt, and depression
about their decision. But for many women these feelings usually are reduced with time.3

Infection of the belly or uterus. This
is rare.

Some couples choose to implant fewer embryos to reduce
the chance of a pregnancy of triplets or more, rather than consider having this
procedure.

2. Compare your options

Have fetal reduction

Carry three or more
fetuses

What is usually involved?

You will have an ultrasound
test to make sure that the fetus or fetuses to be reduced are in their own
amniotic sac. Separate sacs reduce the chance of miscarriage. A different
procedure may be done if the fetuses are in the same sac.

It's done in the doctor's office. It takes only a few
minutes.

You will be watched at the doctor's office afterward to
make sure that the remaining fetuses are doing well.

You will see your
doctor more often during your pregnancy.

You will likely see a
perinatologist. This doctor takes care of women who
may have a problem in their pregnancy.

You may have more tests than
you would in a pregnancy with one fetus.

What are the benefits?

Having fewer fetuses
reduces the risk of miscarriage, stillbirth, premature birth, and
disability.

You have a lower chance of problems in your pregnancy,
such as
gestational diabetes,
preeclampsia, or
anemia. These risks increase with each added
fetus.

It may reduce the stress related to caring for more infants.

It reduces the cost of caring for multiple infants.

You may avoid the emotional stress that some people feel about reducing the number of fetuses.

You have a lower risk of infection.

What are the risks and side effects?

You could
miscarry the remaining fetuses. When reducing from a triplet to a twin
pregnancy, the miscarriage rate is about 6 out of 100 pregnancies. This means that
a miscarriage doesn't happen in 94 out of 100 of these procedures.1 The risk of miscarriage from the procedure is highest when reducing from 6 or more fetuses. The risk of miscarriage is lower if there are fewer fetuses at the start of the procedure.4

You could have an infection in your belly or uterus. This is
rare.

Some parents have grief, guilt, and depression about
reducing the number of fetuses. But these feelings may decrease with time.3

Carrying triplets or more increases the risk of miscarriage, stillbirth, premature birth, and disability.

Multiple pregnancy increases the mother's risk of problems such
as gestational diabetes, preeclampsia, and anemia. These risks increase with
each added fetus.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These
personal stories
may help you decide.

Personal stories about multifetal pregnancy reduction

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"When my husband and I learned we were expecting three babies, we were thrilled. But along with that news we heard about the risks for them and me. I'm already at risk for pregnancy problems, since I've had gestational diabetes before. So we decided to have a multifetal pregnancy reduction. What convinced me was the knowledge that the miscarriage rate is higher for triplet pregnancy than it is for the twins after the procedure. And it went well for us. We took the risk, and the babies and I are doing well."

— Pam, age 37

"Because of my age, our fertility doctor encouraged us to have four embryos transferred for my in vitro. We were surprised that all of them took and were worried about the risks. After talking for a few days about having a multifetal pregnancy reduction, my husband and I decided not to have one. We were more comfortable with letting nature take its course. And it did—by the second trimester, two were gone, and I was carrying twins."

— Maya, age 43

"We knew right away that carrying five babies was not going to work for them or me. So I had a multifetal pregnancy reduction. Then I miscarried. Even though it seemed like the obvious course to take, I'll never stop feeling terrible about it."

— Jenny, age
39

"I just couldn't bring myself to have a multifetal pregnancy reduction, even though my doctor told me that my pregnancy was high-risk. I'll never know whether it would have gone better if I'd had the procedure, but trying to carry the four babies didn't go well. One died after birth, and now we have the challenge of raising triplets, one of which is disabled."

— Joelle, age
35

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have fetal reduction

Reasons to carry triplets or more

I want to increase the chance of having two healthy babies.

I want to try to have all my babies.

More important

Equally important

More important

I want to lower my chance of having a problem like preeclampsia.

I may not have any problems. But if I do, my doctor and I can decide about treatment then.

More important

Equally important

More important

My ethical and spiritual values would allow me to have fetal reduction.

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